title: The SNAP index does not correlate with the State Behavioral Scale in intubated and sedated children.
abstract: BACKGROUND
  Ensuring appropriate levels of sedation for critically ill children is integral to pediatric critical care. Traditionally, clinicians have used subjective scoring tools to assess sedation levels. The SNAP II uses dual frequency processed electroencephalography to evaluate brain activity and may provide an objective assessment of sedation levels.
  
  
  OBJECTIVE
  This study attempts to find an objective method to monitor sedation in critically ill pediatric patients. We compared the SNAP II, a processed electroencephalography device, with the State Behavioral Scale (SBS), a subjective sedation scoring tool. We hypothesize that the SNAP II correlates with the SBS and has less observer bias.
  
  
  METHODS
  This was an IRB approved prospective, observational study. Patients receiving intravenous sedation while being mechanically ventilated were enrolled after informed consent. After the SNAP II monitoring electrodes were attached, blinded bedside nurses assessed sedation levels using the SBS. SNAP indices were collected and compared with SBS scores to determine correlation.
  
  
  RESULTS
  We compared 417 paired data points from 15 patients using Pearson's correlation and least squares means to determine correlation between the SBS and SNAP indices. No correlation was observed. Using covariance model patterning for repeated measures to adjust for covariates again showed no correlation.
  
  
  CONCLUSIONS
  The SNAP index does not correlate with SBS scores in our pediatric intensive care unit (PICU). Its use cannot be recommended to measure levels of sedation in our population. Future research should continue to explore objective ways of measuring sedation in critically ill children.
authors.affiliation: Division of Critical Care Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Thompson
authors.forename: Veronika
authors.initials: V
authors.lastname: Shabanova
authors.forename: John S
authors.initials: JS
authors.lastname: Giuliano
mesh_terms: D000701:Analgesics, Opioid; D002652:Child Behavior / Q000187:drug effects*; D002675:Child, Preschool; D016292:Procedural Sedation / Q000523:psychology*; D003422:Critical Care; D004569:Electroencephalography / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D007223:Infant; D007442:Intubation, Intratracheal / Q000523:psychology*; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D012121:Respiration, Artificial
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives
keywords: benzodiazepines; electroencephalography; intensive care; mechanical ventilation; pediatric intensive care unit; pediatrics